Antonio Augusto Couto de Magalhäes

Ten years of a multidisciplinary diabetic foot team approach in Sao Paulo, Brazil.

Diabetes mellitus can cause devastating foot problems including loss of protective sensation with subsequent ulcerations and amputations. The natural history and pathophysiology of diabetic foot ulcers is best understood and managed by a multiprofessional team approach. The main factors for prevention and treatment of these devastating diabetic foot conditions are shown, with special attention to education of the patient. This approach decreases the morbidity of the disease, besides its economical and social feasibility.

Minimally invasive surgery for diabetic plantar foot ulcerations

Complications of diabetes mellitus constitute the most common indications for hospitalization and non-traumatic amputations in the USA. The most important risk factors for the development of diabetic foot ulcerations include the presence of peripheral neuropathy, vasculopathy, limited joint mobility, and pre-existing foot deformities. In our study, 500 diabetic patients treated for plantar forefoot ulcerations were enrolled in a prospective study from 2000 to 2008 at the Federal University of São Paulo, Brazil. Fifty-two patients in the study met the criteria and underwent surgical treatment consisting of percutaneous Achilles tendon lengthening to treat plantar forefoot ulcerations. The postoperative follow-up demonstrated prevention of recurrent foot ulcerations in 92% of these diabetic patients that maintained an improved foot function. In conclusion, our study supports that identification and treatment of ankle equinus in the diabetic population may potentially lead to decreased patient morbidity, including reduced risk for both reulceration, and potential lower extremity amputation.

Artrodese subtalar do pé pelo método de Ilizarov

There had been heated 28 patients in a total of 29 feet, with na age average of 25,8, predominance in the quality of being male 16 patients (57,2%), white color 25 patients (89,2%), right side 16 patients (57,2%). As the ethiology there were a predominancy of the calcaneum fracture´s consequence 11 patients (37,9%) and poliomyelitis 11 patients (6,9%), bone bar 2 patients (6,9%), primary arthrosis 02 patients (6,9%) abd cerebral palsy 1 patient (3,5%). The average time of consolidation was 3,5 months. There had been used bone graft in 11 patients (44%). There were the necessity to promote the calcaneum extension to raise the pitch of itself, in 2 cases (6,9%). The mounting is simple and it relies on 2 rings transbone settlement through 2 strings fixed in the talus and 2 in the calcaneum. As the result was obtained in 100% of consolidation, pain´s absence and osteopethosis and feet´s great sensibility. In the complications there were found, besides the usual or method itself 1 (3,5%) patient. Showed deep infection in 1 of the strings. The method has showed efficient, independent of the ethiology with 100% of consolidation beyond to permit a certain independancy of the patient during the treatment.

Postural flaccid flat foot treatment through calcaneum slipping osteotomy

Abstract The authors present the results obtained in the treatment of postural flaccid flat feet in 25 patients (50 feet), through the Koutsogiannis technique, to which has been added an inferior displacement of the osteotomised distal fragment of the calcaneum. The technique is presented in brief, and the data obtained are submitted to statistical analysis, which demonstrates the correction of the angular parameters. The final analysis, after an average follow-up of 7 years, showed 20 feet (40%) with excellent results, 26 feet (52%) with good results, and 4 feet (8%) with bad results. The authors suggest the use of the technique for the correction of postural flaccid flat foot deformities in patients over 7 years of age, considering its ease, low morbidity and good results. The postural flaccid flat foot is still a controversial pathology, subject to a wide range of approaches. Varying opinions are found for the determination of the pathology itself, its main deformities and the methods of treatment. 1–3 Nevertheless, a reduced number of patients with flaccid flat feet become symptomatic, with limitation of activity due to progressive functional insufficiency and to secondary deformities. 7 This paper is intended to show the results obtained from the surgical treatment of severe flaccid flat feet, according to the criteria determined by Bleck and Berzins. 1